Saturday, November 22, 2014

Medical Futility Blog: Brain in a Jar - Sufficient Reason to Keep Me Aliv...

Medical Futility Blog: Brain in a Jar - Sufficient Reason to Keep Me Aliv...: I share this treatment preference expressed by Atul Gawande at a recent Oregon Public Broadcasting book event. "If I'm a brain in...

Wednesday, November 12, 2014

Mindfulness Based Stress Reduction: Learn online or from an actual human teacher?

Around 40 years ago, I studied with one of the greatest Tai Chi Ch'uan masters of the last century,  Cheng Man-ch'ing. The thing is, I never studied with him in person. I had his book, which was illustrated with photographs of him doing the movements; The Golden Pheasant Stands On One Leg, Grasp The Sparrow's Tail, The Crane Spreads It's Wings, Step Forward to the Seven Stars of the Dipper, Snake Creeps Down, The Fairy Weaving at the Shuttle, etc. By looking in a mirror I thought I was able to string together a series of movements. Wrong!  I was only twisting and hurting my back and other places doing the exercises. Seven years later I met a Tai Chi Ch'uan teacher and the realization that this ancient art can only be learned by being passed down from teacher to student.

That was before the age of the ubiquitous computer. Nowadays I can watch Tai Chi instructional videos on Youtube all day. I can even switch to other physical activities and watch instructional videos about how to improve my tennis forehand. Ultimately though, I need to really practice the actual art or sport in order to derive any benefit. To really improve at all I should practice with a teacher or coach. There comes a time when we do need to meet human instructors in person to really learn. This is especially true for some of the physiotherapy exercises you can watch on Youtube because I think it is be better to have a physiotherapist prescribe the exercises.  I do know a Tai Chi practitioner who learned the Chan form of Tai Chi by watching videos he had borrowed. He was exceptional in that he already knew and practiced many other of the Tai Chi forms. And this brings me to Mindfulness Based Stress Reduction (MBSR) learning online.

Before I comment about what it is like to learn MBSR online, let's look at the movie the Matrix. If you have seen the movie, you know that when Neo was hooked-up into the Matrix, he learned and later mastered Kung-fu, in addition to several other martial arts, at the speed of digital data transfer and integration into programming. That would be the epitome of hooked-up online learning. The next computerized training ground, that is not science fiction, maybe be Oculus Rift, a newer virtual reality headset that brings into visual perception an immersion experience of three dimensions.

It wasn't that long ago, virtually since the dawn of the WWW, when educators had to face the dilemma of evaluating whether or not one can learn just as well by studying online as one could in a classroom. We can see now how technology, even in science fiction, has grown exponentially to make online learning as common as the air that we breath. That is why before MOOCs there were online courses where you could even get a BA or a college diploma - a real one - without almost seeing a human in person. These initial studies had to look at usability, user interface and digital literacy. They had to research even cognitive measures, how the mind pays attention to a screen, visual studies on effects on the eyes, even worries about the health effects of Wi-Fi wireless transmissions. Anyway, eLearning has made it's mark, and it is going to stick around for a long time.

I have been practicing meditation for many years so I knew about MBSR and the research that has been developed on meditation in neuroscience and medicine. There have been research studies on the effectiveness of meditation not only from Jon Kabat-Zinn, founder of MBSR, but also from Herbert Benson, Richard Davidson, and so many others. I knew that the Buddhist monk Matthieu Ricard (in picture here at left) was in Davidson's fMRI and EEG studies on compassion and the meditating brain.  Just yesterday a new article on the benefits of MBSR and Tai Chi exercise for healing those surviving from breast cancer appeared on the Kurzweil Accelerating Intelligence website.  Cheng Man-ch'ing is smiling and proven right again, as Tai Chi really helped helped him recover from illness.

I have admired the work Jon Kabat-Zinn for many years, though I had never studied his works - until now. I am e-Learning my way through a free online 8 week course based on MBSR, about how it was developed and delivered, as well as the benefits for health that the research has shown.  Before I only knew about the benefits his teachings were having on those in palliative care or who were diagnosed with chronic illness - the meditation as healing medicine model - stress is the silent killer.  I also liked the secular, or one might say, the scientific approach. Now that I have been taking the MBSR course, I really have no qualms about doing so without a human for guidance. This is mostly due to my own experience and learning from meditation teachers, going on retreats, reading, and doing daily practice. I have also studied Buddhism in India, Nepal and Korea. Can't really say that I ever learned meditation before through an online interface. Call me misguided if you will, but I trust my instincts. Well, I did learn Vipassana in a semi-remote sort of way.

Many of the basic techniques in MBSR come from a meditation practice called Vipassana, or insight meditation. The main focus is on watching the breath or mindful awareness of breathing, called Anapanasati in Sanskrit. I did an 11 day Vipassana retreat in Massachusetts taught by S. N. Goenka from Burma. He was not there, but he may as well have been, because they used videos and tapes in the meditation hall to present the instructions. He has many other centres around the world. I thought it was very effective, even though my previous experience with meditation teaching was  learning discipline by sitting at the feet of the masters. This is the main reason why I feel confident in doing an 8 week online MBSR course. Another reason is that the course is exceptionally well designed with guided meditations, readings, video instructions, research articles, teachers with lots of experience- the whole works.  I will provide the link to The MBSR online course that I am following at the end of this post. The online course I am taking is free, but I have looked around and seen some that are not. That 11 day Vipassana course I took in Massachusetts, which including a place to sleep and food, was also free. You give "dana" according to what you think you can.

Generally speaking I would always advise studying with a human presence for a traditional discipline that has been past down for generations, if not millennium. The Tibetan people call the Dali Lama "Kundun", which means "The Presence". Call me a conservative in this respect, but there are just too many subtle things that can go wrong without the guidance of a teacher. On the other hand, I am very, very impressed with the secular or scientific approach of Kabat-Zinn in the design and delivery of the MBSR course.  It would be great however to take the course from him or some of his qualified fellow instructors in person, and I have looked around and there centers and courses locally where it is taught. It is all over the map now.

One criticism I have is learning some basic yoga exercises online, which is one part of the overall MBSR program. Listening or watching videos of yoga postures, and trying to follow along, creates risks of injury, for practitioners of any age. Injury can happen even in a center where a teacher is present, but the presence of the teacher is more reassuring. Learning dynamic movements or mental training is not like reading a book; it is immersive, interactive and interpersonal.  When I was trying to learn Tai Chi Ch'uan from the Cheng Man-ch'ing book by looking in a mirror, I developed aches and pains from unusual twisting of my body. Something similar is happening as I am lying on the floor receiving audio instructions on yoga postures. OK, maybe blame myself for not being careful.  I heard once that physiotherapists are getting a lot of business from people who are just taking up yoga. There are a lot of not so qualified instructors out there. To be fair, there may also be a lot of people who may not have realistic expectations about how to train properly and do not know their limits.

The online MBSR course I am taking is here:
http://palousemindfulness.com/selfguidedMBSR.html
















Friday, October 3, 2014

Optimal Aging Portal is the 'Rotten Tomatoes' of health advice


    Dr. Doug Oliver, associate professor of medicine, uses the new McMaster Optimal Aging Portal. The new website uses evidence summaries, blog posts and web resource ratings to present health information in an easy-to-understand way.
October 1, 2014

Optimal Aging Portal is the 'Rotten Tomatoes' of health advice

Canada’s seniors are increasingly turning to the web to self-diagnose illnesses and maladies – without a clear understanding of whether the information they’re relying on can be trusted.
That will all change today with the launch of the McMaster

Optimal Aging Portal: a go-to place for Canadians to find quality health and medical information on senior life.

The website brings together research evidence about clinical, public health and health systems questions and presents it in an easy-to-understand way.
Key features include evidence summaries, blog posts and web resource ratings, which help to sort through the masses of other resources available online.

Anthony Levinson compared the ratings system to that of popular sites like Rotten Tomatoes, which aggregate user ratings of things like movies.

“There are many other online resources that deal with health and aging available, but what sets the Optimal Aging Portal apart from the crowd is its emphasis on providing only the best evidence, and telling you why it’s considered the best,” said Levinson, an associate professor of psychiatry who leads the design and development of the website and holds the John R. Evans Chair in Health Sciences Educational Research and Instructional Development.

“The portal filters out the noise and makes it easy to understand how scientific evidence and other types of information can help you. We’ve become like the Rotten Tomatoes of health information.”
Suzanne Labarge, McMaster’s Chancellor, has a keen interest in ensuring the public has access to information that can promote healthy aging. In 2012 she gave $10 million to the University to establish the Labarge Optimal Aging Initiative.

“With the web you don’t know who to believe and who to trust. There is so much misleading information around and, frankly, a lot of people are selling snake oil. You really want to know you’re doing something good for yourself, not something stupid. We decided having a trusted source would be really important as part of the Initiative.”

To help the public learn more about the portal, two online discussions are planned.  The first webinar on Oct. 15 from 3 to 4 p.m. will focus on showing citizens how to use the portal’s various features to find information on issues and health concerns. The second webinar on Oct. 21, also at 3 p.m., will focus on how the content of the portal is evaluated, and specifically on the web resources ratings. Information on registration may be found at www.mcmasterhealthforum.org

The portal may be found at http://www.mcmasteroptimalaging.org. The site is already the premier health resource found on the home page of the Government of Canada’s online source for seniors at www.seniors.gc.ca.
- See more at: http://dailynews.mcmaster.ca/article/optimal-aging-portal-is-the-rotten-tomatoes-of-health-advice/#sthash.PLSn1LK6.dpuf

Thursday, October 2, 2014

National Institutes of Health Informatics - Education Series Fall 2014

National Institutes of Health Informatics

Announcing eSafety Series: Ensuring the Safety of our eHealth Systems and Programs
eSafety Series
Ensuring the Safety of our eHealth Systems and Programs

November 19 & 26, 2014
Live, Interactive, Online Sessions - 12:00 -1:30 PM ET
A Joint COACH and NIHI Program
Click Here for More Information

Special Rates for COACH Members and NIHI Colleagues
Patient safety has become a major concern in health care. Key Institute of Medicine and Canadian reports starting as early as 1999, underscore the importance of being safety conscious and proactive in identifying safety risks in healthcare. Today’s eHealth systems are increasingly important in enabling improvements in patient safety, but they can also inadvertently introduce new risks into the healthcare environment.

This online program introduces the COACH eSafety Guidelines: a comprehensive resource for health information professionals and others with a responsibility to ensure that eHealth systems are built and operated in a manner that reduces the risk to patient safety. The Guidelines provide a sound basis for implementing an eSafety Management Program including the assessment of risks using the eHealth Safety Case.
Session 1: Introduction to eSafety & the eSafety Management Program - November 19, 2014
This session will provide a foundation for understanding the issues and opportunities for addressing safety issues in eHealth systems and cover the main steps in setting up an eSafety management program .

Session 2: The eSafety Case - November 26, 2014
This session will introduce the eHealth safety case. The safety case is the safety equivalent of the privacy impact assessment and threat and risk assessment.

Register for eSafety and get 25% off of the coilbound edition COACH eSafety Guidelines. Email Cheryl, ccornelio @ coachorg.com to arrange this discount.  Available only to eSafety session registrants until November 18.
COACH
Canada's Health Informatics Association
NIHI
National Institutes of Health Informatics

Fall 2014 eHealth Education Line-Up
eHealth Future Trends
October 23, 30 & November 6, 2014
Usability Testing Essentials
November 13, 2014

 

National Institutes of Health Informatics
Website:
www.nihi.ca
Contact Us: info@nihi.ca; 1-800-860-7901

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Wednesday, September 24, 2014

Better Health Today - very interesting stores from Health Infoway

Canada Health Infoway (or Infoway)  does a lot of interesting things, while sometimes managing to stay in the background. Their sponsored website "Better Health Together" is digital storying telling about the benefits of health information technology. Although this appears to be just fluffy anecdotal advertising for the benefits of digital health, I suppose there is a need to educate the public. Try taking their Quizz to see if digital health is working for you. Now, this is where we really need to think about doing research on the effectiveness of ehealth systems, and not just collect anecdotes. Nevertheless, I was skeptical that I would see any benefits accruing to myself from the Quizz but was surprised to realize, having had recent encounters with the Family Health Team, that the Electronic Medical Record has been working for my benefit.

Tuesday, September 23, 2014

Twitter feeds about eHealth - Dr. C. Michael Gibson & WikiDoc

I have a twitter feed, ( I like to call it a feed because I still think of Twitter as just a more streamlined sort of RSS reader ) mostly about eHealth , but I do have a life and I am not always following eHealth or posting about it. I currently have 7 people following me (which is not like an RSS newsfeed ). I was flattered to discover not long ago that Dr. C. Michael Gibson, an eminent Harvard cardiologist had followed me from his Twitter. But when I went to his Twitter page, I find out I am only one of 97,400 Twitter feeds he follows. He has made 14,000 tweets and has 120,000 followers! I might be one of those followers who might soon stop following, because while there is information about eHealth, there is also a lot about cardiology and clinical trials. In fact, there is just a ton of information streaming from there and I can't follow it all. I also "subscribed" if that is the word, to the New York Times Health Twitter, which is an incredible fountain of information ( again, too much in fact). But if you want to follow the current Ebola crisis in timely updates, Dr. Gibson's twitter feed seems to be the place to be.

What is also very interesting about Dr. Gibson, is that he must be one of the great eHealth pioneers of his generation, because he was the founder of WikiDoc - the living textbook of medicine -  to which he has contributed thousands of articles. I always did wonder who was writing those articles about medicine on Wikipedia, but it turns out, Wikipedia might not be the best place to get your best information about medicine.

Saturday, August 16, 2014

Eric Topol - Twitter Feed

There is so much information related to health informatics these days. One authoritative source to tap into is the twitter feed of Eric Topol. Many insightful links to articles and information. Who is Eric Topol? His twitter account says "Cardiologist, geneticist, digital medicine aficionado, Editor-in-Chief, Medscape, author of The Creative Destruction of Medicine". He is famous for using an AliveCor Monitor on his smartphone to diagnosis and save the lives of people on airplanes who were having heart distress .< Here >is  a link to an article about that. His twitter feed recently posted an interesting article about a brain stimulation technology that I have been learning more about from researchers, on tDCS.